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By Marni JamesonOrlando Sentinel • Sunday June 23, 2013 8:04 AM

ORLANDO, Fla. — When the American Medical Association declared obesity a disease last week — a
move that instantly labeled one-third of Americans as sick — it launched a controversy not seen
since alcoholism received the disease designation.

Hailed by some obesity experts as a long-overdue victory, the news from the nation’s largest and
most respected medical group was denounced by others who say the move fuels the stigma against
obese Americans.

Activists promptly started the #IAmNotADisease hashtag on Twitter and a petition demanding that
the AMA reverse its position. The petition had nearly 1,200 signatures by Friday.

Calling obesity a disease will open doors to better treatment and better reimbursements, said
Dr. Steve Smith, president-elect of the Obesity Society, which has referred to obesity as a disease
since 2008.

“It adds legitimacy to the problem, will help raise public awareness and will get doctors
engaged in treating the condition,” said Smith, also scientific director of the Florida
Hospital-Sanford Burnham Translational Research Institute for Metabolism and Diabetes, in
Orlando.

The AMA’s decision “is a defining moment,” said Joe Nadglowski, president of the Obesity Action
Coalition, a national nonprofit based in Tampa, Fla., that helps those struggling with obesity. “It
puts obesity on the same path as treatments for addictions to alcohol or tobacco, and mental-health
problems, such as depression.”

A few decades ago, those conditions were also perceived as behavioral problems, said Nadglowski.
“Once we realized they involved a disease process, that drove better coverage, better treatment and
real change.”

In making the call, the AMA aims to reduce the incidence of obesity-related diseases, such as
cardiovascular disease and type 2 diabetes, AMA board member Dr. Patrice Harris said in a statement
accompanying the announcement.

More than 35 percent of Americans currently are obese, the Centers for Disease Control and
Prevention said.

But that doesn’t necessarily mean they’re sick, many argue.

“We don’t see ourselves as diseased,” said Peggy Howell, spokeswoman for the National
Association to Advance Fat Acceptance, a nonprofit group that works to improve the quality of life
for people of large size.

“To label a whole segment of society as diseased without any knowledge of their health is
unacceptable,” she said. “It directly fuels discrimination. This is a step backward.”

Howell, who is 65, added, “I have been fat my entire life. If being fat were so horrific, why am
I not wracked with problems? I have slightly high blood pressure, like a lot of thin people, but
other than that, I perceive myself as a healthy woman, far healthier than a lot of people I know.
But two days ago I was declared diseased.”

Linda Bacon, a nutritionist at University of California at Davis, said, “I’m appalled that the
AMA chose to ignore science and name obesity a disease.”

Bacon, author of
Health at Every Size, joins other critics in noting that the definition of obesity —
basically how one’s weight-to-height ratio stacks up on a BMI chart — is imprecise and defines only
size, not health.

“The AMA just determined that some people are sick based on how they look,” said Bacon. “What’s
next? Will they pronounce being black as a disease because there are higher rates of cardiovascular
disease in black communities?”

Nadglowski of the Obesity Action Coalition thinks the new designation will reduce the stigma
around obesity.

The coalition also has long referred to obesity as a disease based on the complexity of the
issue, he said. “It’s not as simple as pushing away from the table and getting on the
treadmill."

Last year, the American Association of Clinical Endocrinologists joined the coalition and the
Obesity Society in calling obesity a disease.

One change Nadglowski expects to see as a result of the AMA’s position is obese patients’
feeling more comfortable discussing weight issues with their health-care providers. Now that their
condition can be recognized as a legitimate disease, he said, they will feel less ashamed talking
about it with their doctors.

He also hopes the new awareness will improve training in medical schools, where education on
treating obesity is minimal.

Howell, however, believes the label will make those of large size even less likely to seek
medical care.

“A high percentage of doctors still perceive obese patients as those who over-consume fast food
and sugary sodas, and have weak characters,” she said. “The AMA decision won’t change those
attitudes overnight.”

Other critics of the new classification say that obesity is not a disease, but a risk factor for
other diseases.

“Obesity itself is not necessarily a disease,” said Bacon. “If we are concerned about disease,
let’s focus on disease.”

The fact that obesity contributes to as many as 60 illnesses amplifies the need for obesity to
be treated specifically, said Smith. “To just treat all the diseases that result misses the
opportunity to address the root cause.”

Moving forward, he said, now that “what has been a very healthy debate” has come to an end, “It’s
time for us to get serious about treating obesity. We have to call it what it is.”